NEW HIRE CONSENT FORM FOR SUBSTANCE ABUSE SCREENING TEST
PRE-EMPLOYMENT PHYSICAL EXAM
It is the policy of Baldwin County that all applicants, who either are likely to be offered employment or who have been extended an
offer of employment, undergo a routine pre-employment physical exam.
iring decisions may be based upon the results of medical tests conducted as part of this examination process.
STATEMENT OF COUNTY POLICY
It is the policy of the County to maintain a safe work environment conducive to effective business operations.
The County requires that personnel and operating practices be consistent with the highest standards of health and safety.
Selling, purchasing, using, possessing, or being under the influence of any illegal substance, without medical
authorization, during the work day, on the County premises or while conducting county business is inconsistent with the
County’s business interests and will be grounds for disciplinary action, up to and including termination.
Re: Authorization to Perform the Urine and/or Breath Testing:
I, __________________________________________, understand that by accepting employment with Baldwin
County Commission, I agree willingly to participate in the urine and/or breath testing program under the provisions set
forth on the alcohol and controlled substance abuse policy.
understand that if I decline to sign this consent and thereby decline to take the test, the medical examination will
not be completed, and my employment offer will be rescinded.
If the test is confirmed as positive, the results will be reported to the Personnel Department. An exception will be
made for the use of legally prescribed medications taken under the direction of a physician.
Re: Authorization to Perform the Medical Examinations:
I also hereby authorize and give my consent to a qualified medical representative and/or physician to conduct the
above-mentioned physical examination to also include, without limitation, a drug screening urine analysis all as part of the
pre-employment requirements of Baldwin County.
understand that, submitting to such examinations does not guarantee employment with Baldwin County.
understand that if I decline to sign this consent form and further decline to take the physical exam as has been
requested, then the medical examination will not be completed, and an offer of employment will either not be extended or
will be withdrawn, if previously made.
Re: Authorization to Release Sensitive Medical Information:
I further authorize Baldwin County’s designated physician, medical personnel or testing facility to release to
Baldwin County any and all results of such physical examination and testing along with any relevant medical information.
Signature:________________________________ Print Name:_______________________________